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Continue on the back if necessary What could have been done to prevent this injury/near miss What parts of your body were injured If a near miss how could you have been hurt Did you see a doctor about this injury/illness If yes whom did you see Doctor s phone number Date Has this part of your body been injured before If yes when Time Your signature Supervisor s Accident Investigation Form Name of Injured Person...
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If Your Employee Is Injured
Immediately After an Accident ... To ensure early notice of employee claims, L&I will now mail claim arrival notices ... Stay Involved with Your Employee's Claim.
First Report of Injury form; fatality, serious injury reporting -- workers ...
The First Report of Injury (FROI) form is the reporting document for all work- related ... The employee must be given a copy of the FROI form, with the employee ...
Employers First Report of Injury | NH Department of Labor - NH.gov
There are presently two options for completing the Employer's First Report of Injury form and filing it with NH Department of Labor. ... Hampshire Government website. Smaller text size Reset text size Larger text size. skip navigation. Employees
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